The objective of the proposed project is to identify the determinants of women's utilization patterns that are associated with not receiving routine cervical cancer screening. Preliminary evidence suggests that gaps in coverage of the population at risk are due to post-childbearing medical care practices and utilization. The specific aims of the project are to: (1) identify health care utilization patterns of cervical cancer patients with a matched control group; (2) to ascertain the extent to which identified utilization risk factors and other factors are found in the middle aged and elderly general population and their current early detection practices; (3) to ascertain the extent to which providers' knowledge, attitudes and practices concerning cervical cancer detection for the elderly are consistent with or contribute to patients' utilization and detection practices. The implications of the study are in the design of provider and organization-oriented interventions and for patient-oriented programs to improve the coverage of this high risk population. To meet these objectives, a three phase study is proposed in which the results of each component accumulates evidence for the succeeding phase. A case-control study of 200 cases of cervical cancer and matched neighborhood controls will be fielded with patients accrued from the Division of Gynecologic Oncology of the Johns Hopkins Hospital. Retrospective histories of utilization practices will be obtained to identify sources of interruption in or not having ever received routine Pap testing. The second phase is a cross-sectional survey of 1,200 middle-aged (45-64) and elderly (65+) women in Maryland who will be interviewed by telephone to ascertain the extent to which identified risk factors from the case-control study are prevalent in the middle-aged and elderly female population. The final phase consists of a cross-sectional two-part survey of health care providers of the specialty types serving middle-aged and elderly women in Maryland. The telephone and mailed survey effort will determine the extent to which providers' knowledge, attitudes and practices influence the provision of cervical cancer screening for the elderly and for women in the middle years, groups not receiving routine Pap testing. The congruence between the behavior of women and the beliefs and practices of providers will then be determined. As cervical cancer is considered to be a preventable cause of death, only with documentation of risk factors can more targeted programs be developed.